This is my release form for my AS media course.

1. Release Form
To Whom It May Concern:
I (the undersigned) herby grant to ____________________ the right to photograph me, record my voice,
performances, poses, actions, plays, appearances, use of my picture, photograph, silhouette and any productions of
my physical likeness in connection with the production titled ____________________
I herby grant to ____________________, their successors, assigns and licences the perpetual right to use all still,
motion pictures and sound track recordings, recordings that you make of either me and my voice, the right to use my
name, advertising, exploiting and/or publicizing of the picture. I also grant the right to reproduce in any manner
whatsoever any recordings including all instrumental, musical, or other sound effects produced by me in connection
with the production and/or post-production of the picture.
I agree that I will not claim or maintain against ___________________________, your
successors, assigns, licensees, any claim, action, suit, demand of any kind or nature
whatsoever, including but not limited to those grounded upon invasion of privacy, rights of
publicity or other civil rights, or for any reason in connection with your authorized use of my
physical likeness and sound in the Picture as herein provided.
By my signature here I understand that I will, to the best of my ability, adhere to the schedule
agreed to prior to the beginning of my engagement. Additionally, I agree, to the best of my
ability, to make myself available should it be necessary, to rerecord my voice and/or record
voice-overs and otherwise perform any necessary sound work required after the end of filming.
Should I not be able to perform such sound work, I understand that
__________________________may enter into agreement with another person to rerecord my
dialogue and/or record voice-overs and use this sound work over my picture or however they
deem appropriate.
I further acknowledge and agree that any commitments beyond the scope and intent of this
release are the sole responsibility of the above named production, or its duly appointed
representative(s) and NOT the “Name of Company”.

2. Name:
Number:
Age:
Signature:
Date: